The fastening of tissues has long been a need in the medical industry, and correspondingly, a finite number of fastening devices have been developed for different applications and uses. Among these devices are laparoscopic fastening devices or tackers which are often used with minimally invasive procedures such as laparoscopic repair of hernias, and the like. A typical laparoscopic procedure involves the insertion of thin, elongated instruments into relatively small incisions or access ports in the abdomen to access hernia defects in the abdominal wall from the inside. Moreover, the laparoscopic instruments are used to position a prosthetic mesh over the defect and fasten the prosthetic mesh against the inner abdominal wall using tacks, or the like.
Conventional laparoscopic tackers provide a relatively thin and elongated tubular member containing deployable tacks and having an end-firing mechanism positioned at the distal tip thereof. In particular, the end-firing mechanism is configured to deploy tacks directly from the tip of the elongated member in an axial manner, and thus, ideal application suggests positioning the elongated member perpendicularly against the tissue surface to be tacked. However, due to several factors, such as the relatively rigid and elongated nature of the laparoscopic tacker, the limited locations and number of access ports available, and the typical location of hernia defects, it is difficult to position the end of the laparoscopic device squarely against the inner wall of the abdomen. In practice, a surgeon using a laparoscopic tacker typically positions the tacker with one hand, sometimes even slightly bending the instrument while using his other hand to press against the outer wall of the abdomen, in order to achieve the best possible angle for installing the tacks.
Due to the limited access to hernia defects and the minimally invasive nature of typical hernia repairs, laparoscopic tackers tend to use simple-action type mechanisms to deploy tacks, and correspondingly, employ tacks with basic means for fastening prosthetic mesh to the inner abdominal wall. More specifically, conventional tackers employ screw-type or simple push-type actions to install tacks with threads or barbs which help embed the tacks within abdominal tissue. Over time, especially in the case of metal, coil-shaped tacks, these tacks may cause irritation or pain to the patient, become dislodged from the abdominal wall, or cause other complications post-surgery. To address such drawbacks associated with metal tacks, absorbable tacks have been developed and employed. Absorbable tacks are designed to be eventually absorbed by the body, and thus, cause less irritation or pain to the patient over time. However, absorbable tacks also tend to provide holding or tensile strength that is less than optimal.
Another problem encountered by surgeons while using conventional laparoscopic devices is the difficulty with which to finally deploy a given fastener into the desired region of tissue. More specifically, a successful fastening or suturing process requires not only proper insertion of the fastener into tissue, but also proper release of the fastener from the fastening device and into the tissue. Due to the tough and/or fibrous nature of some types of tissue, it may be physically challenging to quickly and neatly release a fastener into the tissue while operating the fastening device by hand. To address this issue, some devices offer convenience features such as fully automated and/or simple-action mechanisms which insert as well as release the fastener in a single action. While such convenience features may facilitate fastener installation, these features also compromise the degree of control the surgeon has over the installation process. En particular, these convenience features tend to perform both the insertion and the release actions too quickly, suddenly and/or discretely, thereby limiting tactile feedback to the surgeon and resulting in an undesirable disconnect from the fastening process. Also, depending on the force or speed with which such convenience features insert or release fasteners, there is a potential for tissue trauma or bleeding.
Accordingly, there is a need for minimally invasive or laparoscopic means of fastening tissue which provides a more effective and reliable means for closing tissue and/or fastening prosthetic mesh to tissue. There is also a need for a medical fastening or suturing device which employs fasteners or sutures that reduce irritation, pain, and other complications to the patient without adversely affecting holding strength. Furthermore, there is a need for a medical fastening or suturing device which not only facilitates the insertion, release and deployment of fasteners or sutures into tissue, but also provides the surgeon with sufficient control throughout the process.